Extracorporeal cardiopulmonary resuscitation for out-of-hospital cardiac arrest - who, when, and where?

Abstract

Purpose of reviewExtracorporeal cardiopulmonary resuscitation (ECPR) is an invasive and resource-intensive therapy used to care for patients with refractory cardiac arrest. In this review, we highlight considerations for the establishment of an ECPR system of care for patients suffering refractory out-of-hospital cardiac arrest (OHCA). Recent findingsECPR has been shown to improve neurologically favorable outcomes in patients with refractory cardiac arrest in numerous studies, including a single randomized control trial. Successful ECPR programs are typically part of a comprehensive system of care that optimizes all phases of OHCA management. Given the resource-intensive and time-sensitive nature of ECPR, patient selection criteria, timing of ECPR, and location must be well defined. Many knowledge gaps remain within ECPR systems of care, postcardiac arrest management, and neuroprognostication strategies for ECPR patients.

In-hospital extracorporeal cardiopulmonary resuscitation for patients with an out-of-hospital cardiac arrest in a semi-rural setting: An observational study on the implementation of a helicopter emergency medical services pathway

“…ECPR is best implemented within a system that optimizes all aspects of cardiac arrest care. 1 Currently in the UK, bystander CPR is only attempted in 7 out of 10 patients with OHCA, and AED’s are used in only 1 in 10 cardiac arrests. 24 When no bystander CPR is provided during the first minutes of the arrest, patients with initially shockable rhythms will eventually deteriorate into asystole, often before arrival of HEMS, as we have noted in our study population.…”

“…Extracorporeal cardiopulmonary resuscitation (ECPR) can be used as a treatment for patients with an out of hospital cardiac arrest (OHCA) when standard resuscitation fails. 1 , 2 In these patients, ECPR is used as a technique to provide oxygenated circulation especially to the brain, thereby extending the time window to diagnose and treat the primary underlying cause of the arrest, such as a primary cardiac cause, intoxication, a pulmonary embolism, or hypothermia. Over the past decade, a 10-fold increase in ECPR utilisation has been observed.…”

Extracorporeal Cardiopulmonary Resuscitation

“…For both adults and pediatric patients, candidates for eCPR should follow these guiding principles, but no universal criteria exist 4,5,7,9,11,13,[19][20][21][22][23] : (1) the cardiac arrest must be witnessed either in hospital or out of hospital; (2) the patients should receive early, continuous high-quality CPR per Advanced Cardiovascular Life Support or Pediatric Advanced Life Support4 before eCPR cannulation; (3) although not well defined, there should be a "short" low-flow period before eCPR cannulation; (4) there should be a reversible cause for the cardiac arrest where the perfusion from the ECMO circuit serves as a bridge to recovery; and (5) the treating facility must have a robust multidisciplinary system in place to facilitate rapidly moving patients from site of arrest to site of cannulation to intensive care unit.…”

Mechanische Kreislaufunterstützung im Schock

“…Darüber hinaus empfiehlt die Surviving Sepsis Campaign die Evaluation einer venovenösen ECMO bei Patienten mit ARDS [89]. dardtherapie wird [96,97,98]. Sehr viel Sekundärliteratur wurde in letzter Zeit über das Thema ECPR publiziert, auf welches die Autoren zur weiteren Vertiefung verweisen [93,99].…”